Health Minister says GP system is ‘broken’ as Govt marks first 100 days

Friday, 8 March 2024

General practice is an integral part of our health system. But some of those working in it say it’s a system on the brink of collapse; with GPs burning out, closing their books, and critical workforce pressures. Hannah Martin reports in this three-part series.

Friday, March 8 marks 100-days of the coalition Government.

Stuff this week reported concerns from some on the frontline about the state of general practice, so asked Health Minister Dr Shane Reti ‒ a former GP ‒ to reflect on the Government’s actions so far, and what it is going to do to address a system many say is at a “tipping point”.

In a phone interview on Tuesday, Reti said his thoughts on general practice were no different to when he was in opposition: “Fundamentally, general practice is broken, and it’s been broken for a number of years.”

The Government’s 49-point agenda for their first 100 days in office included a number of health reforms and some controversial moves ‒ including introducing legislation to disestablish Te Aka Whai Ora (the Māori Health Authority) and repealing amendments to the ‘smokefree’ laws.

Both were very unpopular policies among the health workforce and Māori health advocates.

Earlier, Reti said that Te Aka Whai Ora had not delivered much-needed results during its first 18 months.

This week, Reti told Stuff he was “very pleased” with what’s been achieved from their “ambitious” 100-day plan.

In its plan, the Government set out to sign a memorandum of understanding for a third medical school, take first steps to extend free breast cancer screening, reallow the sale of pseudoephedrine and improve ED security – all of which it has taken steps toward.

Work setting out five targets for the health system would be brought into public domain in the next few days, he said on Tuesday.

Reti said the 100-day plan was a “substantive body of work” which had occupied a “fair piece of time since we came into Government”.

“[I’m] very, very pleased to be able to deliver them.”

So, where does that leave general practice?

Some on the frontline expressed hope that having a former GP as health minister could see increased acknowledgement on the value of primary care by officials.

In its briefing to the incoming minister from December 2023, the Royal New Zealand College of General Practitioners said they needed to see action in the form of sustainable investment and ongoing improvement in five key areas.

These were addressing the workforce crisis (and training more doctors), health equity, sustainable funding of general practice, valuing fellowship and supporting quality training.

In his interview with Stuff, Reti said there were several parts of general practice which concerned him, namely workforce, retention and remuneration.

He was “encouraged” in several areas, including further medical school training spots available and the MoU with Waikato to grow a third medical school pending a cost-benefit analysis, to help in the long-term, and by the number of GP registrars this year.

But he said “more needs to be done”.

When asked whether he or this Government would make a commitment to increase funding for primary care and general practice, Reti said there were two parts to this: first, looking at existing funding and how the pie could be redistributed.

He acknowledged that a recent report found capitation, the existing GP funding model, was a “blunt tool”.

Under this model, if you’re a 50-year-old man and the healthiest person in the country, your general practice will receive exactly the same funding as the most ill 50-year-old man in the country.

“I don’t think there’s anyone in general practice who doesn’t agree that where the work is done, where the morbidity is highest, that’s where the funding should mostly go.”

Reti was also of the view that “general practice just needs new pie”.

Reti said his general policy statement, which will identify his high-priority issues, will be released shortly; but broadly three key things he will prioritise are workforce, targets and infrastructure.

“Within that, general practice and primary care will have a key role to play… [as] a high priority for me.”

“We’ve talked about - every government's talked about - keeping people out of expensive hospitals. That's primary care. And then early discharge [from hospitals], that’s primary care as well.”

Primary care has been the “sound-bite” towards solutions, but it’s been hard to see substantive steps made to implement and progress the sound-bite “into something actionable,” he said.

What can be done differently?

Funding was a major solution suggested by GPs spoken to by Stuff.

The baseline capitation model had to change to recognise complexity, comorbidity (where a patient has more than one condition) and deprivation, many said.

There were also other solutions posed.

West Auckland-based GP Dr Mamaeroa David (Te Whakatōhea, Ngai Tūhoe, Ngāti Porou, and Niuean) is a “massive advocate” for bringing in non-doctor healthcare workers to help share the workload.

She pointed to the vaccinating health workforce as an example of how non-doctor health providers could provide care from someone who represented the cultures and communities with which they work.

With fewer than 5% of GPs identifying as Māori, and 2% identifying as Pasifika, this doesn’t reflect the wider population.

These non-doctor health workers also often have specialised expertise, David said: at her practice, they have health coaches who specialise in managing chronic care, such as diabetes, and health improvement practitioners who offer free 30-minute mental health consults.

Having other parts of the primary care team help pick up some of this work helps to decrease the burden on GPs, allowing them to focus on sicker, more complex patients, and gives mental health appointments the time and aroha they require, David said.

You can find parts one and two of the GP series here and here.